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Friday, June 23, 2017

Comparing the Major Provisions of PPACA to the House and Senate Replacement Proposals with Audio from Armstrong & Getty

Overarching Thoughts:

1) The Senate absolutely did not “start over” but simply made a few tweaks to the Obamacare Lite bill passed by the House. I’d call this Senate version Obamacare Lite Plus.

2) If you didn’t think the House bill went far enough to repeal Obamacare, you will really hate the Senate bill because, on the whole, it backtracks a few steps toward Obamacare.

3) If I were evaluating these bills based upon how they addressed the problems we faced in healthcare in 2010, I’d grade Obamacare an F, House Bill a D- and Senate Bill an F+.

4) If evaluating these bills today, knowing Obamacare is the law of the land I’d grade the House bill as a C+ and the Senate bill as a C.

Pros:

Both the House and Senate bill repeal all but one Obamacare tax.

Both the House and Senate bill eliminate the Individual and Employer mandates.

Both bills allow for larger use of HSAs and FSAs.

Both bills permit the states a bit more freedom in dealing with many of Obamacare’s coverage mandates.

Both bills phase out the Medicaid expansion ushered in by Obamacare. The House bill does it sooner but the Senate bill does it in greater degree in the long run assuming politicians could stick to benefit reductions – but we know they cannot.

Cons:

All three plans cement a redistribution of wealth and new federal entitlement of $1.5 to $1.75 trillion dollars.

None of the three laws significantly work to reduce the cost of healthcare in America in a meaningful enough way to avert future economic turmoil.

The House or Senate bill probably prolong our slide into socialized medicine but only by a couple of years. At this pace the U.S. will end up in some form of rationed and socialized healthcare in 7 to 10 years.

Subsidy amounts based on an ins. plan designed to cover
70% of medical expenses.

Bases subsidy amounts on age as opposed to income or
plan cost. Would be least dollars redistributed of the three plans.

Subsidy amounts based on a plan that is designed to
cover 58% of medical expenses.

Preexisting
Conditions

Coverage cannot be denied or cost more.

States can get permission to let insurers charge more
for some preexisting conditions. States would have access to federal money to
help those with expensive policies or conditions.

Insurance companies would be required to accept all
applicants regardless of health status and charge them the same premium just
like in O’care. But the draft bill would let states ask permission to reduce some
required coverages.

Eliminates 20 of the 21 new taxes, delays Cadillac Tax
from 2020 to 2026

Eliminates 20 of the 21 new taxes, delays Cadillac Tax
from 2020 to 2026

Medicaid

Obamacare expanded Medicaid from persons at 100% FPL to
138% FPL and promised the federal government will pay 90% of that expansion.
31 states took that deal.

Would limit Medicaid reimbursement by a per-enrollee
cost, based on 2016 average costs. And phase out the expansion in 2020.

Allows the 31 states that expanded Medicaid to continue
getting federal funding through 2023, with reduced funding starting in 2021.
The bill sharply curtails federal support for Medicaid expansion in 2024,
likely causing many states to end the expansion. Deeper proposed cuts could
begin in 2025.

Preserves the subsidies through 2019, then eliminates
them altogether.

Prohibitions on
annual

and lifetime
limits

Bars insurers from setting a limit on how much they have
to pay to cover someone.

Preserves this rule, but gives states the option to eliminate
it as part of a waiver of insurance market rules.

Preserves this rule, but gives states the option to
eliminate it as part of a waiver of insurance market rules.

Underwriting
Premiums for Older vs. Younger Americans

Bans insurers selling policies directly to individuals
from charging their oldest customers more than three times what they charge
their youngest ones thereby unfairly burdening the young with higher premiums.